H.R. 4710 — No Surprises Act Enforcement Act

This section increases civil penalties under the Public Health Service Act (§2723(b)(2)(C)), ERISA (§502(c)), and the Internal Revenue Code (§4980D(b)) against group health plans and health insurance issuers for violations of specified No Surprises Act balance billing protections to $10,000 per individual or per failure (from $100 per day during the noncompliance period). The specified protections—paralleled across the three statutes in §§716(a)(1)(A)-(B) and (C)(i),(ii),(iii),(v), 716(b)(1)(A),(B),(E), and 717(a)(1)-(2) (PHSA §§2799A–1(a)(1), (b)(1), and 2799A–2(a))—prohibit balance billing patients for emergency services, nonemergency services by out-of-network providers at in-network facilities, air ambulance services, and related patient-provider choice requirements.

This section amends the No Surprises Act's requirements for payments following an independent dispute resolution (IDR) determination for out-of-network emergency services, nonemergency services at in-network facilities, and air ambulance services under the Public Health Service Act (PHSA) and Employee Retirement Income Security Act of 1974 (ERISA) (i.e., PHSA §§2799A-1(c)(6) and 2799A-2(b)(6); ERISA §716(c)(6) (29 U.S.C. 1185e(c)(6))) to do the following: (1) require the provider or facility (if the IDR amount is less than its initial payment plus patient cost-sharing) or the plan or issuer (if greater) to make or refund the difference within 30 days of the determination; (2) require notification to the Secretary of such payments upon making them; and (3) impose a penalty equal to three times the difference between the initial payment (or $0 if denied) and the out-of-network rate (less patient cost-sharing), plus interest specified by the Secretary, for late or non-payment. (Thus, the changes apply bidirectionally to enforce timely compliance with IDR outcomes and deter payment disputes.)

This section revises audit reporting requirements for health insurance issuers under the Public Health Service Act (PHSA, 42 U.S.C. 300gg-111) and group health plans under the Internal Revenue Code (IRC §9816), which implement protections against surprise medical bills and other health coverage transparency rules. For the PHSA, it requires (1) initial annual reports to Congress from 2022 through December 31 of the enactment year on the number of audited plans and issuers; and (2) subsequent reports, beginning February 1 of the year after enactment and every six months thereafter, to specified House and Senate committees—in coordination with the Secretaries of Labor and Treasury—detailing semi-annual audit and enforcement data, including total audits conducted, complaint numbers from providers and enrollees, enforcement actions, civil monetary penalties (total number and aggregate amount), non-monetary corrective actions, and the three most common violations. Parallel requirements apply under the IRC, with reports coordinated by the Secretaries of Labor and Health and Human Services covering "applicable sections" (IRC §§9816-9825).